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Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Exam Sample Questions (Q49-Q54):
NEW QUESTION # 49
Reasonable and customary charges for health care are based primarily on:
- A. Actuarial tables
- B. Average charges within a geographic area
- C. Insurance industry studies
- D. National physician surveys
Answer: B
Explanation:
Reasonable and customary charges (Insurance Article, § 15-1005) reflect average fees for procedures in a specific geographic area (e.g., 80th percentile), ensuring fair reimbursement. Actuarial tables, studies, and national surveys aren't the primary basis.
References:Maryland Insurance Article, § 15-1005; MIA health insurance guidelines.
NEW QUESTION # 50
All of the following are true of insurance EXCEPT:
- A. It is a means of sharing losses
- B. It eliminates risk
- C. It protects against uncertainty
- D. It transfers risk
Answer: B
Explanation:
Insurance (Insurance Article, § 1-101) transfers risk, shares losses, and protects against uncertainty, but it mitigates, not eliminates, risk, which remains inherent.
References:Maryland Insurance Article, § 1-101; MIA insurance basics.
NEW QUESTION # 51
In Maryland, a group accident and health certificate of insurance must contain:
- A. The insurer's financial statement
- B. A summary of policy features and benefits
- C. A copy of the group contract
- D. A list of all participating physicians
Answer: B
Explanation:
Certificates (Insurance Article, § 15-1207) summarize policy features and benefits for group members, not the full contract, physician lists, or financial statements, which are separate or irrelevant. This ensures employees understand their coverage.
References:Maryland Insurance Article, § 15-1207; MIA group insurance rules.
NEW QUESTION # 52
All advertisements for health insurance shall make clear the identity of the:
- A. Insured
- B. Beneficiary
- C. Insurance Commissioner
- D. Insurer
Answer: D
Explanation:
Advertisements must identify the insurer (Insurance Article, § 27-503) to ensure transparency and avoid confusion. The Commissioner, beneficiary, and insured aren't required in ads, as they don't issue the policy.
References:Maryland Insurance Article, § 27-503; MIA advertising guidelines.
NEW QUESTION # 53
A health maintenance organization (HMO) must provide coverage for all of the following EXCEPT:
- A. Dental and vision care
- B. Emergency services
- C. Well-baby or well-child care
- D. Routine physical examinations
Answer: A
Explanation:
Maryland HMOs (Health-General Article, § 19-701) must provide basic health services like routine physicals, well-child care, and emergency services. Dental and vision care, however, are not required unless specified as supplemental benefits. State law mandates pediatric care but excludes routine dental and vision from standard HMO coverage unless the plan explicitly includes them.
References:Maryland Health-General Article, § 19-701; Insurance Article, § 15-1201; MIA HMO guidelines.
NEW QUESTION # 54
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